Breast Reconstruction

Serving Manhattan, New York City and Surrounding Areas.

Feel Whole Again after Breast Cancer

For many breast cancer survivors, breast reconstruction is an important component of the healing process. Recreating one or both breasts after cancer helps a woman to feel complete, regain self-confidence and comfortably wear her clothing. Dr. Mark H. Schwartz appreciates the opportunity to work with New York City’s breast reconstruction patients and offers several reconstruction options using different techniques and technology. In each case, he closely consults with the individual patient and her medical team to determine the best course of treatment. The vast majority of breast reconstruction begins at the same time as the mastectomy. However, it can be delayed until a patient has healed from the mastectomy and recovered from other cancer treatments.

There are two categories of breast reconstruction. One makes use of breast implants, the other makes use of your own tissues. Both of these techniques are described below.

Tissue Expander/Implant Procedure

Breast reconstruction with tissue expanders and implants is a multi-stage procedure that gradually expands the remaining natural breast skin and muscle to safely create a pocket for the implant. In the first procedure, which is performed through the same incision as the mastectomy, the tissue expander is placed under the pectoralis major muscle and partially filled with saline. This procedure takes about an hour to perform, and a general anesthetic is used. If performed with the mastectomy most patients stay in the hospital one to two days. If performed at a later date it is typically done as an outpatient.

After an initial healing period, the expansion process begins by inserting additional saline into the tissue expander at regular intervals. Each tissue expansion procedure takes several minutes to complete. The expanders have a port in the front that can be easily accessed to inject the saline. Most patients feel little or no discomfort during the expansion process. Any discomfort can be managed with Tylenol or other over-the-counter medications.

Once the expansion process is complete and a sufficient pocket has been created, the tissue expander is exchanged for a permanent silicone or saline implant during a second procedure. Patients can choose between several different implant types to pick the one that best fits their body and goals for surgery. While patients have the option of either type of implant, most women find that silicone implants produce a look and feel more similar to natural breast tissue. The implant shape and size are matched to the opposite remaining breast as best as possible. If both breasts are being reconstructed, the patient can select the implant shape and size she desires.

This outpatient procedure takes about an hour to perform.

Approximately four to six months after the implant exchange, a nipple areola reconstruction can be performed, which is described below.

The entire process usually takes approximately six to eight months to complete, after which patients can experience the benefits of reconstructed, relatively natural-looking breasts, which can diminish the reminders of cancer.

The advantage of this reconstruction is that aesthetically pleasing results are achieved with a relatively rapid recovery. There are no extra scars other than what is necessary for the mastectomy. The disadvantage of an implant reconstruction is that it may not be an exact match with the normal breast. Some women chose to undergo a breast lift, breast reduction, or breast augmentation on the unaffected breast for the most symmetric, aesthetically pleasing outcome.

Flap-Based Reconstruction

The alternative to implant-based reconstruction involves using a flap of the patient’s own skin, muscle and fat to recreate the breast mound. The flap is taken from another area of the body, most commonly the transverse rectus abdominis myocutaneous (TRAM) flap is taken from the abdomen, and the latissimus dorsi (LD) flap is taken from the back. The flap may be completely detached from the body, or tunneled underneath the skin to the chest, where it is sculpted into a breast.

Patients who had radiation in the past are usually good candidates for flap reconstruction. In addition, some women are hesitant to have an implant device placed, and opt for the more natural flap approach. The main drawback of the flap procedures is that the recovery period can be longer than implant-based reconstruction, because they involve two surgical sites.

TRAM Flap

The transverse rectus abdominis myocutaneous (TRAM) flap is the most commonly performed flap used to recreate the breast mound. For many women, this procedure is successful in naturally reconstructing the treated breast. It is not ideal for extremely thin women with not enough abdominal tissue, or those who are too obese, as they may be at an increased risk for complications.

During the TRAM flap procedure, an incision will be made in the lower abdomen to lift layers of skin, fat, muscle and blood vessels. A tunnel is created under the skin to relocate the tissue to the breast area and the breast mound is then carefully reshaped with these tissues.

Breast reconstruction with a TRAM flap often takes four to five hours to perform and most patients stay in the hospital for two to four days. There is an additional scar in the lower abdominal area and patients are likely to experience tightness for several weeks. It may take six to eight weeks to return to full activity. Regardless of the recovery, a TRAM flap breast reconstruction is able to produce a breast that looks and feels natural, and matches the opposite breast.

Approximately four to six months after the TRAM flap, a nipple areola reconstruction can be performed which is described below.

Latissimus Flap

The latissimus dorsi (LD) flap consists of muscle, skin, and fat taken from the back and moved through a tunnel to the front of the chest to create a breast. The LD flap remains attached to the back after surgery to ensure proper blood flow to the flap. An implant may be placed under the flap if more volume is needed to match the opposite breast size. Most women are good candidates for this type of breast reconstruction regardless of body shape.

LD flap breast reconstruction takes two to three hours to perform, and patients usually stay in the hospital for one to three days. It may take four to six weeks to return to full activity. Since this procedure requires two surgical sites (breast and back), recovery is longer than an implant procedure, but shorter than a TRAM flap procedure. The additional scar on the back can be concealed underneath a bra strap.

Approximately four to six months after the LD flap, a nipple areola reconstruction can be performed which is described below.

Nipple Reconstruction

Nipple and areola reconstruction is often the final step in breast reconstruction surgery. The nipple is created after the reconstructed breast has settled into place so that the new nipple matches the appearance and position of the natural one as closely as possible. Nipple reconstruction may be performed using one of several techniques, including the use of one’s own chest skin and tissue, skin grafts, and tattooing. This is always an outpatient procedure and can be performed with either a local anesthetic or sedation. Depending on the type of reconstruction performed, patients can return to work the next day or several days later, and can resume strenuous activities in approximately two weeks.

Other Considerations

In both implant- and flap-based reconstruction procedures, the goal is to produce a breast that looks and feels natural, and matches the opposite breast. If needed, Dr. Schwartz can modify the other breast through the placement of breast implants, breast reduction or breast lift techniques, to produce the desired appearance.

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Dr. Mark H. Schwartz

Mark H. Schwartz, MD, FACS, is a board-certified plastic surgeon with over 20 years of experience making confidence-building, positive transformations in his patient’s lives. Recognized by Castle Connolly as one of the New York Metro Area’s top plastic surgeons, he looks forward to discussing your interest in plastic surgery and developing an individualized treatment plan.